A dislocated collarbone is a common injury that can be accompanied by complications and therefore requires competent and timely treatment. There are two types depending on the location: acromial (near the acromial process of the scapula) and sternal (near the sternum).
In addition to classification by location, dislocations are distinguished by severity:
- complete dislocation of the collarbone;
- incomplete dislocation (subluxation).
Clavicle dislocation is often diagnosed in representatives of amateur and professional sports, most often in gymnasts, volleyball players, ballet dancers, dancers, etc. Elderly people and those suffering from pathologies of the musculoskeletal system are also at risk.
The causes of clavicle dislocation are:
- falling on the shoulder;
- swipe;
- sharp jerk.
Complete dislocation vs subluxation of the clavicle
Incomplete dislocation of the clavicle is an injury in which only one ligament is torn, which fixes and holds the bone in the articular fossa, therefore only partial deformation of the joint is noted. Symptoms of a subluxated clavicle are not as obvious as a dislocation, however, there may be limited mobility of the arm, muscle weakness and moderate pain, so often a victim with a subluxation prefers not to contact a specialist, but to treat it independently. Subluxation of the clavicle occurs for the same reasons as dislocation, only the impact is less intense.
A dislocation of the clavicle is accompanied by a complete rupture of the articular ligaments, so the head of the bone falls out of the articular fossa. The symptoms clearly indicate a dislocation, since it is clearly visible that the bone has moved from its anatomical position. Treatment for clavicle subluxation is much faster with minimal risk of complications.
A little anatomy
The clavicle is a small, S-shaped curved tubular bone, which at one end connects to the sternum (sternoclavicular joint) and at the other end to the acromial process of the scapula (acromioclavicular joint). Traditionally, the clavicle is divided into three parts: the sternal end, the diaphysis (middle part) and the acromial end.
The main injuries to the collarbone are fractures and dislocations. Since the clavicle has two ends (acromial and clavicular), dislocations can occur at both the acromial and sternal ends. More often there are dislocations of the acromial end. Several ligaments are attached to the collarbone, which connect it to the scapula.
Dislocation of the acromial end of the clavicle
When a victim is admitted to the hospital with a dislocated clavicle, in most cases he is diagnosed with a dislocation of the acromial end of the clavicle. With this type of dislocation, the bone protrudes upward. In addition to the symptoms common to different types of dislocation (swelling, hematoma), the characteristic signs of this type of dislocation are:
- very severe pain, which is localized at the junction of the collarbone with the scapula and intensifies when trying to raise the arm;
- "key" symptom. The shoulder is fixed under the elbow and pressure is applied to the collarbone. If it “goes” to its place without resistance, but when the impact stops it springs back up again - this indicates an acromial dislocation of the clavicle.
Conservative therapy
Many people are interested in how to properly set a dislocated collarbone, how can they treat the injury with home remedies? Is treatment possible at home? Treatment at home is possible, but at the final stage, during the rehabilitation period, following all the recommendations of the attending physician. You cannot reset a dislocated bone yourself. It is difficult for one person to do this, and besides, the collarbone, even if it can be adjusted easily, is not held in the correct position.
In a medical facility, the normal position of the bone is restored using local anesthesia.
To fix the collarbone, the doctor chooses various methods, taking into account the type of injury and its severity:
- for acromial dislocation, a thoracobrachial bandage can be used in addition to a plaster or plastic bandage;
- In case of sternal type of injury, plaster or soft bandages corresponding to the nature of the injury are used.
On average, the duration of wearing a fixing bandage is three to four weeks.
To quickly restore performance, physiotherapy (electrophoresis, ozokerite treatment, etc.) and physical therapy are prescribed.
Dislocation of the sternal end of the clavicle
A rarer type of injury is sternal dislocation or dislocation of the sternal end of the clavicle. This is due to the fact that the ligaments provide a strong attachment to the sternal end. Depending on which direction the bone was displaced, there are three subtypes of sternal dislocations:
- prosternal, characterized by forward displacement of the bone;
- suprasternal, characterized by displacement of the bone forward and upward;
- retrosternal, when the bone goes inward. Substernal dislocation of the clavicle is considered the most traumatic for joints and nerves and is often accompanied by extensive bruising.
Sternal dislocation of the clavicle is accompanied by characteristic symptoms, which makes it easy to differentiate. The pain intensifies significantly when breathing and often limits the ability to take a deep breath.
Causes of injury
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The most common cause of dislocation is a fall, when the main blow is taken by the shoulder or arm, as well as a severe bruise of the sternum. Similar injuries are diagnosed in volleyball players, handball players, football players and athletes involved in contact sports. And rapid or complicated childbirth leads to dislocation of the collarbone in the newborn.
Unlike adults, young children recover quickly from injury. For treatment, only a light fixing bandage and, if necessary, painkillers are used.
External manifestation of dislocation.
Dislocation of the acromial end of the clavicle occurs as a result of direct and indirect effects of applied forces. Much less often, the cause of injury is a combination of these mechanisms. During the downward displacement of the scapula, the collarbone is also involved in the process, colliding with the first rib bone. A kind of lever is formed, the fulcrum of which is located on the rib, and the restraining force is in the clavicular-sternal joint. It acts on the acromial end, provoking its displacement to the upper position. The scapula deviates downward, squeezing the capsule and ligaments. If the applied force was excessive, then they are injured - partially or completely torn. What happens as the scapula moves further down:
- the clavicular-sphenoid ligaments lose their integrity;
- if the collarbone is no longer fixed by ligaments as a result of injury, then the arm moves downward, since the center of gravity has completely shifted;
- the acromial end of the clavicle moves upward.
Dislocation of the sternal end of the clavicle can be suprasternal, retrosternal and prosternal. The classification is based on the direction of displacement of this small mixed S-shaped bone. With dislocations of any location, soft tissue joint components are damaged. Injury to the most powerful restraining structure—the capsule—is especially dangerous . The victims are diagnosed with damage to small and large blood vessels, which cause numerous hemorrhages.
Symptoms and signs of a dislocated clavicle
When only one ligament is damaged, a dislocated clavicle is manifested by mild pain, and the victim may not attach much importance to this and treat the damage at home. However, this is fraught with the development of complications in the future.
The main symptoms of a dislocated collarbone are severe pain, limited movement, decreased sensitivity of the skin above the collarbone, swelling and redness of the skin, as well as obvious deformation of the joint.
The diagnosis is made by a traumatologist. He interviews the victim, examines and palpates him, records specific signs of a dislocated collarbone and sends him for an x-ray. Based on the data obtained, the doctor makes a diagnosis and determines a treatment regimen. Sometimes an MRI scan is required.
Clinical manifestations
Immediately after injury, the victim experiences severe pain, spreading to the upper body and intensifying with inhalation. Movement in the joint is so limited that the person is unable to raise his arm. The most characteristic symptoms of a dislocated clavicle, regardless of its location:
- skin sensitivity decreases, a feeling of numbness occurs;
- the collarbone area rapidly swells and the skin turns red;
- deformation of the clavicular-sternal or clavicular-acromial joint is visualized.
If the injury is not complicated by ligament ruptures or only one of them is damaged, then victims do not always seek medical help. The damage causes mild pain, slight swelling, and slight limitation of movement. Such an injury is called a subluxation and, in the absence of medical intervention, provokes the development of severe complications, which can only be eliminated by surgery. With sternoclavicular dislocation, the patient, when visiting a traumatologist, complains only of pain and decreased range of motion. Pain is felt on palpation, especially when the doctor tries to lift his arm.
The initial diagnosis can be made already at the stage of examining the victim. If a prosternal dislocation occurs, then a protrusion of the clavicle is visible in the damaged area, and a retrosternal injury is visualized in its retraction.
A similar diagnostic technique is used to determine dislocation of the acromial end of the clavicle. In this case, the upward protrusion of the collarbone is clearly visible. When the doctor puts a little pressure on the acromial end, it returns to its natural position. As soon as the pressure eases and stops, the acromial end begins to move and rise.
The initial diagnosis is confirmed or refuted after instrumental studies, the most informative of which is radiography . A dislocation of one of the sections of the clavicle is indicated not only by the fairly variable width of the joint space. The main sign of such injuries is a change in the position of the lower part of the clavicle and its acromial end. Their presence at the same level means the integrity of the ligamentous apparatus and the absence of dislocation. If the collarbone is displaced upward on the X-ray image, then pathology therapy begins immediately.
First aid for a dislocated collarbone
First aid for a dislocated collarbone involves applying cold (you can use an ice pack wrapped in a thin towel) to the area of injury and then securing the arm with a bandage. The victim should be given a pain reliever and call an ambulance or take him or her to the traumatology department yourself.
It is very important to avoid attempting to self-reduce a dislocation. This can lead to serious consequences, including damage to nerves or blood vessels.
Diagnostics
Patella luxation
Diagnosis of injury is carried out upon arrival of the victim to a medical facility. Based on external signs, the doctor will make a preliminary diagnosis if atypical protrusion of the bone is visible, swelling of the soft tissues is present, and palpation in the area of the acromial or sternal end of the clavicle brings painful sensations to the victim. After this, the doctor will send the patient for an x-ray.
Signs of damage to the outer end of the clavicle bone are clearly visible on an x-ray. You can consider the position of the process of the scapula and the acromial end of the bone - they will be located at an angle to each other. An X-ray is taken and, if necessary, a dislocation of the sternal edge is diagnosed - in comparison with a healthy clavicle, the dislocated bone will be located abnormally, not symmetrically. The shadow from the inner end of the bone will overlap the shadow of the vertebrae.
If there is a need for more detailed diagnostics, the doctor will prescribe magnetic resonance imaging. This method, although more expensive, makes it possible to examine all structures - soft tissues, blood vessels, neighboring organs and nerve endings. Diagnosis based on MRI results is the most complete.
Reduction of a dislocated clavicle
Reduction of a dislocated clavicle is considered a painful procedure, so it is only done under local anesthesia. As a rule, the doctor acts in tandem with an assistant. Once the bone is back in place, the shoulder is immobilized. The most commonly used is a figure-of-eight bandage that passes through the sternum and over the shoulder and securely fixes the arm in the desired position. Other fixation methods can also be used:
- Deso bandage;
- thoracobrachial bandage;
- Volkovich method;
- McConnell bandage (for mild dislocation of the acromial end).
In addition to the bandage, special inserts will be installed that apply pressure to the collarbone and a cushion in the armpit. Plaster is applied extremely rarely for a dislocated clavicle.
Conservative treatment of clavicle dislocation
Conservative treatment of clavicle dislocation involves reduction, fixation and medication.
The traumatologist will prescribe:
- non-steroidal anti-inflammatory drugs, which also have an analgesic effect;
- chondroprotectors, restoring cartilage tissue and promoting elasticity and strength of ligaments;
- vitamin complex or preparations containing calcium;
- local application of healing ointments.
They may also prescribe electrophoresis to relieve pain and relieve inflammation and UHF therapy to restore ligaments and speed up the healing process. Cold compresses will be indicated in the first days after injury.
Surgical treatment of clavicle dislocation
Repositioning the clavicle after a dislocation is a complex manipulation that cannot always correct the situation. In such cases, surgical intervention is required.
Indications for surgical treatment are:
- sternal dislocation of the clavicle;
- ineffectiveness of conservative measures;
- old dislocation of the collarbone.
The doctor stitches the torn ligaments and fixes the bones using silk threads or metal knitting needles. After the operation, the arm is given an abduction position and a cast is applied, which should be worn for at least 2 weeks.
Surgery for a dislocated clavicle can be performed using several methods:
- using metal knitting needles;
- using screws that provide tighter fixation, but cause low hand mobility;
- sewing on buttons;
- plastic surgery of joint ligaments.
The last method is the most effective.
Rehabilitation after a dislocated collarbone
Rehabilitation after a dislocated collarbone involves the victim undergoing a course of physiotherapy, massage, and exercise therapy. As a rule, hand functionality returns one and a half to two months after the injury. It takes about a month to strengthen the muscles. At first, the rehabilitator will recommend performing exercises without using the shoulder joint. The load will be directed to the wrist and elbow joint. Only after some time will exercises for the shoulder joint be added. In addition, exercise therapy for a dislocated collarbone will include exercises for the neck.
Full recovery after a dislocated collarbone also involves following a diet high in calcium and trace elements involved in strengthening bones and ligaments.
Dislocations with complications require long-term and complex rehabilitation - at least 8 weeks.
Complications and consequences after clavicle dislocation
The following are possible complications and consequences after a dislocated collarbone:
- nerve conduction disorders;
- muscle and tendon rupture;
- vascular injuries;
- disorders of the lymphatic system;
- chronic joint diseases.
A timely visit to a traumatologist will quickly neutralize the discomfort caused by the injury, as well as minimize the likelihood of complications.